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The Ministry of Health Malaysia aims to fully replace liquid-based cytology (LBC) with Human Papillomavirus (HPV) tests and increase the screening coverage from a baseline of 25% to 40% by 2023, followed by a 10% yearly increment until 70% coverage. This transition requires proper planning, including the number of tests needed and budget allocation. This study aims to simulate different transition strategies involving the shift from LBC to HPV testing with expanded screening coverage to predict their impact on cervical cancer elimination in Malaysia. A system dynamics model was developed to simulate the transition from LBC to HPV testing and HPV vaccination coverage in Malaysia. The dynamic model utilised local epidemiological data, published research, and expert opinion when data was unavailable. The simulation showed that a combination of high HPV vaccination coverage and transitioning fully to five-yearly HPV testing by 2030, coupled with a 70% screening uptake by 2040, would accelerate cancer elimination in Malaysia by 18 years with an estimated screening cost of MYR1.81 billion equivalent to USD 411 millions compared to the baseline of using LBC as the primary screening method (MYR1.39 billion, USD 315 millions). Sustained, it would lead to averting 6,000 new cancer cases by 2070. Alternatively, conducting HPV screenings twice before age 50 would advance cervical cancer elimination by 14 years and prevent approximately 1000 new cases by 2070, with an estimated cost of MYR1.13 billion equivalent to USD 257 millions. A delay in achieving the full transition prolonged the elimination more than a delay in increasing the screening coverage. In all scenarios, yearly vaccination of 90% of girls age 13 is crucial to achieving elimination. In the Malaysian context, where HPV vaccination coverage has reached considerable levels, the evidence advocates for a full transition from LBC to HPV testing, ideally by 2030. While expanding screening coverage remains a critical factor in this endeavour, the findings unequivocally endorse prioritising the transition process. Trial registration: Trial registration number: NMRR ID-22-00187-DJU.
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Detecção Precoce de Câncer , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Neoplasias do Colo do Útero/diagnóstico , Malásia/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Detecção Precoce de Câncer/métodos , Adulto , Pessoa de Meia-Idade , Vacinação , Adolescente , Programas de Rastreamento/métodos , Adulto Jovem , CitologiaRESUMO
@#Objective: Effective prevention and control measures are essential to contain outbreaks of infectious diseases, such as coronavirus disease (COVID-19). Understanding the characteristics of case clusters can contribute to determining which prevention and control measures are needed. This study describes the characteristics of COVID-19 case clusters in Malaysia, the method used to detect a cluster’s index case and the mode of early transmission, using the seven cluster categories applied in Malaysia. Methods: This cross-sectional study collected publicly available data on COVID-19 clusters occurring in Malaysia from 1 March 2020 to 31 May 2021. The characteristics of cases were described by category, and their associations with several outcomes were analysed. Descriptive analyses were performed to explore the method used to detect the index case and the mode of early transmission, according to cluster category. Results: A total of 2188 clusters were identified. The workplace cluster category had the largest proportion of clusters (51.5%, 1126/2188 clusters), while the custodial settings category had the largest median cluster size (178 cases per cluster) and longest median duration of cluster (51 days). The high-risk groups category had the highest mortality. There were significant differences in cluster size, duration and rate of detection across the categories. Targeted screening was most commonly used to detect index cases, especially in custodial settings, and in imported and workplace clusters. Household–social and social–workplace contacts were the most common modes of early transmission across most categories. Discussion: Targeted screening might effectively reduce the size and duration of COVID-19 clusters. Measures to prevent and control COVID-19 outbreaks should be continually adjusted based on ongoing assessments of the unique context of each cluster.
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The proportion of Malaysians of all ages who use private outpatient services has dropped over time, highlighting the overstretched condition of public outpatient facilities compared to their private counterparts. This paper aims to determine the prevalence of outpatient care, characteristics of outpatient care users by sector, and the factors affecting the utilisation of private outpatient services among the adult population of Malaysia using Andersen's behavioural model. Data from the National Health Morbidity Survey 2019 (NHMS 2019), a nationwide survey, were analysed. Logistic regression analysis was performed to explore the association of predisposing (locality, age, sex, ethnicity, education level, and marital status), enabling (working status, health care coverage, and household income), and need factors (perceived and evaluated needs) with the use of private outpatient services. Variables with a statistical significance ≤ 0.25 in the univariate regression analysis were included in the final multivariable logistic regression analysis. A total of 11,674 respondents, estimated to represent 22.4 million adults aged 18 years and above in Malaysia, were included for analysis. Overall, 8.3% of the adult population of Malaysia used outpatient care and 33.9% used the private sector. Those living in urban areas (OR = 1.80, 95% CI = 1.02, 3.18), non-Malays (OR = 1.74, 95% CI = 1.04, 2.93), those working (OR = 2.47, 95% CI = 1.48, 4.10), those with employer coverage (OR = 4.73, 95% CI = 2.79, 8.01), and those with health problems (OR = 2.26, 95% CI = 1.26, 4.05) were more likely to utilise private outpatient services. Those who self-rated their health status as fair (OR = 0.54, 95% CI = 0.33, 0.91) and who had diabetes, hypertension, or hypercholesterolemia (OR = 0.56, 95% CI = 0.31, 1.02) were less likely to utilise private outpatient services. The predisposing and enabling factors were associated with the use of private outpatient services, and the need factors were strong predictors of private outpatient care utilisation among adults. Understanding the factors associated with the utilisation of private outpatient services could aid in the development of effective initiatives designed to enhance outpatient care access among the population of Malaysia and balance the burden of outpatient care provision on the public and private sector.
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Assistência Ambulatorial , Atenção à Saúde , Adulto , Humanos , Malásia/epidemiologia , Setor Privado , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The translation of person-centred care concepts into practice requires fulfilment of necessary components, including person-centred values and practice held by the employees and having a supportive system. The objectives of this study were multifold: firstly, to evaluate the measurement model, secondly, to examine the roles of prerequisite or attributes of healthcare providers and care environment and how they affect delivery of person-centred processes; and finally, to examine the mediating effect of care environment towards the relationship between prerequisite and care processes. METHODS: A cross sectional study was conducted among healthcare providers working in primary care facilities in a state in Malaysia. The Person-centred Practice Inventory-Staff instrument (PCPI-S) was distributed and completed by respondents. The instrument structure, reliability and validity were assessed through confirmatory factor analysis, while the framework's unidirectional hypothesis and the mediation path hypothesis were analysed using structural equation modelling. RESULTS: The overall goodness of fit verifies the original Person-centred Practice Framework, allowing some correlation errors. There were significant relationships between prerequisites of healthcare providers and care environment (ß = 0.826, p < 0.001), as well as between care environment and care processes (ß = 0.785, p < 0.001). This analysis also proved that care environment plays a partial mediating role in the relationship between prerequisites and care processes. CONCLUSIONS: In order to successfully move towards delivering person-centred practice, it is imperative to equip healthcare providers with person-centred values and beliefs, while at the same time transform current work culture to align with person-centred care. This will allow successful delivery of person-centred processes. TRIAL REGISTRATION: NMRR-18-309-40,447.
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Pessoal de Saúde , Assistência Centrada no Paciente , Estudos Transversais , Humanos , Análise de Classes Latentes , Reprodutibilidade dos TestesRESUMO
This study aimed to highlight the COVID-19 response by the Ministry of Health (MOH) and the Government of Malaysia in order to share Malaysia's lessons and to improve future pandemic preparedness. The team conducted a rapid review using publicly available information from MOH, PubMed, and World Health Organisation (WHO) Global Research on Coronavirus Disease Database to compile Malaysia's responses during the COVID-19 pandemic. Measures taken between 31 December 2019 and 3 June 2020 were classified into domains as well as the pillars described in the WHO COVID-19 Strategic Preparedness and Response Plan (WHO SPRP). Malaysia's response incorporated all pillars in the WHO SPRP and consisted of five domains, (i) whole-of-government, (ii) cordon sanitaire/lockdown, (iii) equity of access to services and supports, (iv) quarantine and isolation systems, and (v) legislation and enforcement. Some crucial measures taken were activation of a centralised multi-ministerial coordination council where MOH acted as an advisor, with collaboration from non-government organisations and private sectors which enabled an effective targeted screening approach, provision of subsidised COVID-19 treatment and screening, isolation or quarantine of all confirmed cases, close contacts and persons under investigation, with all strategies applied irrespective of citizenship. This was provided for by way of the Prevention and Control of Infectious Diseases Act 1988. A combination of these measures enabled the nation to contain the COVID-19 outbreak by the end of June 2020.
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Tratamento Farmacológico da COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Humanos , Malásia , Quarentena , SARS-CoV-2RESUMO
BACKGROUND: The increase in the elderly population, chronic and degenerative diseases, as well as accidents at work and on the road in Malaysia would result in an increased demand for informal care. This paper aimed to determine the associated factors of informal caregiving and its effects on health, work and social activities of adult informal caregivers in Malaysia. METHODS: The data from the 2019 National Health and Morbidity Survey (NHMS), a nationwide cross-sectional survey with a two-stage stratified random sampling design, was used in this research. The study included respondents who were 18 years and older (n = 11,674). Data were obtained via face-to-face interviews using validated questionnaires. Descriptive and complex sample logistic regression analyses were employed as appropriate. RESULTS: 5.7% of the adult population were informal caregivers. Provision of informal care were significantly associated with the female sex (OR = 1.52, 95% CI [1.21, 1.92]), those aged 36-59 years (OR = 1.61, 95% CI [1.15, 2.25]), and those who reported illness in the past 2 weeks (OR = 1.79, 95% CI [1.38, 2.33]). The risk of having their health affected were associated with female caregivers (OR = 3.63, 95% CI [1.73, 7.61]), those who received training (OR = 2.10, 95% CI [1.10, 4.00]) and those who provided care for 2 years or more (OR = 1.91, 95% CI [1.08, 3.37]). The factors associated with the effects on work were ethnicity, received training and had no assistance to provide the care. In terms of effect on social activities, female caregivers (OR = 1.96, 95% CI [1.04, 3.69]) and caregivers who received training were more likely (OR = 2.19, 95% CI [1.22, 3.93]) to have their social activities affected. CONCLUSION: Our study revealed that sex, age, and self-reported illness were factors associated with being an informal caregiver in Malaysia. Informal caregivers faced effects on their health, work, and social activities which may be detrimental to their well-being. This understanding is crucial for planning support for caregivers.
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Cuidadores , Adulto , Idoso , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Malásia/epidemiologia , MorbidadeRESUMO
Despite various efforts introduced, private health insurance coverage is still low in Malaysia. The objective of this article is to find the factors associated with not having a private health insurance in Malaysia. We analyze data involving 19 959 respondents from the 2015 National Health Morbidity Survey. In this article, we describe the prevalence of not having health insurance and conducted binary logistic regression to identify determinants of uninsured status. A total of 56.6% of the study population was uninsured. After adjusting for other variables, the likelihood of being uninsured was higher among those aged 50 years and above, females, Malay/other Bumiputra ethnicities, rural, government/semigovernment, self-employed, unpaid workers and retirees, unemployed, lower education level, without home ownership and single/widowed/divorced, daily smoker, underweight body mass index, and current drinker. The likelihood of being uninsured also increased with increasing household size while the inversed trend was seen for household income. A substantial proportion of population in Malaysia did not have private health insurance, and these subgroups have limited preferential choices for provider, facility, and care.
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Seguro Saúde , Pessoas sem Cobertura de Seguro de Saúde , Emprego , Feminino , Humanos , Malásia/epidemiologia , População RuralRESUMO
Access to improved water and sanitation is essential. We describe these practices in Malaysia using data from a nationwide community survey and used logistic regression to assess the determinants. Of the 7978 living quarters (LQs), 58.3% were in urban areas. About 2.4%, 0.5% and 27.4% of LQs had non-improved water sources, non-improved toilet types and improper domestic waste disposal, respectively. Open burning was practiced by 26.1%. Water source was a problem for long houses (10.5%), squatters (8.5%) and shared houses (4.0%). Non-improved toilet types were 11.9% for squatters and 4.8% for shared houses. Improper domestic waste disposal practices were higher for occupants of village houses (64.2%), long houses (54.4%), single houses (45.8%) and squatters (35.6%). An increase in education or income level was associated with a decrease in improper domestic waste disposal methods. House type significantly affected water and sanitation after adjusting for the effects of other variables. Lower household income was associated with non-improved toilet types and improper domestic waste disposal. Lower education and rural location influenced domestic waste disposal. The water and toilet facilities in Malaysia were generally good, while domestic waste management practices could be improved. There remain pockets of communities with environmental challenges for the nation.